The Code of Medical Ethics and the Challenge of Professional Identity Formation

Personal Identities, Professional Identity Formation, and Implications for Physician Professionalism

Audiey Kao, MD, PhD Vice President, Ethics Name as Identity

I thought you were a woman physician.

3 © 2018 American Medical Association. All rights reserved. Patient-Physician Concordance • Studies examining the effect of gender and racial concordance in the patient-physician relationship have revealed mixed results.

• Even if the effects are positive, it is infeasible to achieve gender and racial concordance across every patient-physician interaction and relationship.

• Even if it was feasible, there are certain patient requests for concordance that should not be fulfilled.

Personal Gender Professional Identity Race PIdentity Religion Attributes Attributes

• Within medical education, PIF is a multi-faceted process by which medical students transition from laypersons to physicians.

• From a physician’s perspective, PIF is the process of internalizing a profession’s core values and beliefs.

• From a patient’s perspective, PIF is how these internalized values and beliefs manifest in a physician’s professional obligations.

Establishing Ethical Norms and Obligations

Personal Professional P Beliefs Obligations

Indonesia, 2010 Congo, 2012 Austri a, 2014 Indi a, 2012 USA, 2002 Germany Munich Perinatal, 2014 Germany Munich Turkish, 2016 Denmark, 2012

0 20 40 60 80 100 percent

Strongly agree Agree Di s ag re e Strongly disagree

9 © 2018 American Medical Association. All rights reserved. Ethical Opinion 1.1.7 Physician Exercise of Conscience • Physicians are: • expected to uphold the ethical norms of their profession, but • they are not defined solely by their profession, and thus • should have latitude to practice in accord with well-considered, deeply held personal beliefs.

• Preserving opportunity to act (or to refrain from acting) in accordance with conscience is important for preserving the integrity of the individual physician and the medical profession.

• Physicians are expected to: • provide care in emergencies, and • honor patients’ decisions to refuse life-sustaining treatment. • Physicians have stronger obligations to: • patients with whom they have a longstanding relationship; • when there is imminent risk of patient harm such as due to delay in needed care; • and when the patient is not able to access needed treatment from another physician.

• Before entering into a relationship, make clear to patients any specific services you cannot provide in good conscience.

• Take care that your actions do not discriminate against individual patients or populations of patients.

• Inform patients about all relevant options for treatment, including options to which you morally object to.

• In general, you should refer a patient to another to provide treatment you decline to offer.

Thank You for the Opportunity